S13) Pathophysiology and Management of Spinal Cord Injuries Flashcards
Label the following structures in the spinal cord anatomy
What is the general cause of spinal injuries?
Most often caused by physical trauma – cars, contact sports, assault, falls and alcohol
What are the different mechanism of injury to the spinal cord?
- Hyperflexion
- Hyperextension
- Lateral stress (sideways movement)
- Rotation
- Compression (force along the axis of the spine downward from the head / upward from the pelvis)
- Distraction (pulling apart of the vertebrae)
What are the different ways that flexion injuries might occur?
Often leads to neurological injury:
- Fractures – anterior wedge, flexion teardrop
- Dislocations – anterior subluxation, bilateral interfacet dislocation, antlanto-occipital dislocation, anterior atlanto-axial dislocation
What are the different ways that extension injuries might occur?
- Fractures – Hangman’s, teardrop
- Dislocation – anterior atlanto-axial dislocation
What are the causes of Complete Cord Transection Syndrome?
- Trauma
- Infarction
- Transverse myelitis
- Abscess
- Tumour
What are the five clinical features of Complete Cord Transection Syndrome?
- Complete loss of sensation below the lesion
- Complete paralysis below the lesion
- Spinal shock and autonomic dysfunction with higher lesions
- Hypotension
- Priapism (prolonged sustained erection)
What are the causes of Brown-Séquard Syndrome?
- Penetrating trauma
- Fractured vertebrae
- Tumour
- Abscess
- Multiple sclerosis
What are the clinical features of Brown-Séquard Syndrome?
- Side of injury – loss of motor function (corticospinal tract), loss of conscious proprioception, vibration and touch sensations (dorsal column)
- Contralateral side of injury – loss of pain and temperature sensation (spinothalamic tract)
What are the causes of Anterior Cord Syndrome?
- Flexion injury – leading to fractures or dislocations of vertebrae or herniated discs
- Injury to the anterior spinal artery – due to vascular/atherosclerotic disease in the elderly, iatrogenic secondary to cross-clamping of aorta
What are the clinical features of Anterior Cord Syndrome?
Autonomic dysfunction – bowel, bladder, sexual function
What are the causes of Central Cord Syndrome?
- Trauma (C-spine hyperextension in elderly / hyperflexion in young)
- Disruption of blood flow to the spinal cord
- Cervical spinal stenosis
- Degenerative spinal disease
- Syringomyelia
- Central canal ependymoma
Describe the following for syringomyelia in Central Cord Syndrome:
- Aetiology
- Symptom development
- Modalities lost
- Modalities preserved
- Aetiology: unknown, due to development of a syrinx (cyst) in/within central canal
- Symptom development: arise from obliteration of spinothalamic fibres decussating in the white commissure
- Modalities lost: painful and thermal stimuli
- Modalities preserved: light touch, proprioception
What are the clinical features of Central Cord Syndrome?
- Motor > Sensory
- Upper extremity > Lower extremity
- Distal > Proximal
- Bladder dysfunction and urinary retention
Posterior Cord Syndrome is a very rare condition.
What are its possible causes?
- Chronic pathological processes – spondylosis, spinal stenosis, infections, vitamin B12 deficiency
- Occlusion/infarction of the paired posterior spinal arteries
What are the clinical features of Posterior Cord Syndrome?
Describe the non-surgical management of spinal cord injuries
- Intubation (C5/above)
- ICU admission
- Early immobilisation of the C-spine
- C-spine restriction (approx. six weeks)
- Physiotherapy / OT
Describe the surgical management of spinal cord injuries
- Progressive neurological deficits
- Unstable spinal fractures
Describe the ABCDE approach in the initial evaluation and treatment of spinal cord injuries
- Airway (ask patient to talk)
- Breathing (resp rate, saturation, accesory muscles)
- Circulation (capillary refill, BP, HR, fluid challenge)
- Disability (GCS, AVPU, neuro exam, blood sugar)
- Exposure (rashes, scars)
In the initial evaluation and treatment of spinal cord injuries, when should one assume that the patient has an injury?
Assume spine injury if:
- Head injury present
- Unconscious or confused
- Spinal tenderness
- Extremity weakness
- Loss of sensation
In seven steps, outline the emergency management of a patient with spinal cord injuries
⇒ Continue ABCDE approach
⇒ Continuous vital sign monitoring (HR, RR, BP)
⇒ Address hypoxia → O2 ± airway adjuncts
⇒ Address hypotension → fluid challenge, vasopressors
⇒ Address hypothermia → additional blankets
⇒ Neurological examination
⇒ Assess bladder volume & distension → insert urinary catheter
One can “clear” the C-spine using the NEXUS method.
What are its six pre-requisites?
- Alert & oriented (to person, place, time, and event)
- No language barrier
- Not intoxicated
- No midline posterior tenderness
- No focal neurological deficit
- No painful distracting injuries
